Dysfunctional coping in headache: Avoidance and endurance is not associated with chronic forms of headache

Abstract

Introduction: About 4% of the population suffer from daily or near daily headache, which in most cases evolved from an episodic type of headache. The impact of psychological factors on this process is unknown. It seems reasonable to assume, that besides somatic and social conditions psychological factors like pain-related coping and cognition play an important role, as has been shown for other pain conditions. Methods: We performed a cross sectional study on pain coping behaviour in 211 patients with migraine and tension type headache. Pain-related cognition and coping was investigated using the Kiel Pain Inventory. Prevalence of depression, medication intake and headache characteristics were analysed in regard to chronicity of headache. Results: Overall pain intensity was high in the patient sample. The level of depression increased with headache frequency. Dysfunctional coping, characterized by fear and avoidance is frequently used by headache patients. As in low back pain, also endurance is highly prevalent. Other features known to be associated with chronic headache, like depression and medication overuse, could be confirmed.

Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

“…A correlation between pain and depression has been highlighted in patients with traumatic brain injuries (Dobscha et al, 2009 ; Garden and Sullivan, 2010 ), complex regional pain syndrome (CRPS) type I and II (Lohnberg and Altmaier, 2013 ; Rewhorn et al, 2014 ), spinal cord injury (Craig et al, 2013 ; Avluk et al, 2014 ; Van Gorp et al, 2015 ), peripheral diabetic neuropathies (Yoshida et al, 2009 ; Rekleiti et al, 2013 ), muscular dystrophies (Alschuler et al, 2012 ), Parkinson's disease (Zhang et al, 2014 ; Kass-Iliyya et al, 2015 ; Mao et al, 2015 ; Rana et al, 2016 ), fibromyalgia (Scheidt et al, 2014 ), and post-herpetic neuralgia (Drolet et al, 2010 ). Moreover depression is associated with anxiety in patients with headache (Kröner-Herwig et al, 2008 ; Wieser et al, 2012 ). The presence of neuropathic components in the pain experienced by the patient correlates with higher values for depressive and anxious symptomatology (Radat et al, 2013 ; Shaygan et al, 2013 ; Uher and Bob, 2013 ); in case of complex conditions the comorbidity with major depressive disorder is high (Proctor et al, 2013 ).…”

“…In particular, an external locus of control (perception of not having control over the headache) together with high levels of anxiety, depression and pain catastrophizing are associated with a higher probability of chronification of attacks (Radat et al, 2009 ). Contrary to musculoskeletal pain, dysfunctional coping strategies such as avoidance of social activities, are not always associated with worsening of the patient's condition (Wieser et al, 2012 ). Neuropathic pain conditions are characterized by discomfort due to pain intensity and allodynia.…”

Effects of Flexibility in Coping with Menstrual Pain on Depressive Symptoms

“…This supposition is generally referred to as the coping flexibility hypothesis (CFH). Some CFH frameworks for chronic pain were proposed, and the CFH was supported among chronic pain sufferers, such as those with rheumatoid arthritis, multiple sclerosis, cancer, and functional dyspepsia . In a study of chronic headache, coping flexibility incrementally contributed to decreased severity in subsequent depressive symptoms, beyond chronic headache coping strategies.…”

Multimodal Physiotherapy Based on a Biobehavioral Approach as a Treatment for Chronic Tension-Type Headache: A Case Report

“…These treatments are increasingly included in clinical practice, but we believe that physical rehabilitation should integrate a biobehavioral approach to treating patients with CTTH. Importantly, it has been observed that psychosocial factors such as depressive symptoms, dysfunctional coping, and fear-avoidance beliefs could be involved in the chronicity of headaches ( 9 ).…”